I spend a lot of time advising people on how often they should get screened for STDs, but sometimes it's not that simple. Not all that infrequently, I hear stories from individuals who ask their doctors for an STD test and are told no. Sometimes the doctors have good reasons for not testing for STDs, but other times they are simply ill-informed about risk and other related information. Here are some of the main reasons why doctors refuse to do STD testing, along with explanations for why you might, or might not, want to get a particular test anyway.
Screening guidelines exist for a reason. Their goal is to target the highest risk populations and maximize testing efficiency while minimizing waste of time, money, and resources. The only problem is that people aren't populations.
There are many reasons why people might wish to be tested for STDs more often than recommended by guidelines, or at an age that the guidelines don't recommend testing for at all. Such reasons might include:
- Multiple sexual partners
- A history of unprotected sex
- Starting a new sexual relationship
- Finding out that a past partner was unfaithful
That's why if you have a good reason why doctors should ignore screening guidelines in your case, you should always tell them. They'll probably listen.
Some diagnostic tests require particular types of collection equipment, doctor expertise, or laboratory supplies that are not available to all physicians. If you want, or need, to be tested for a disease where that is the case, and your doctor doesn't have the materials she needs to perform it, then the only solution is to go to another doctor or laboratory for testing.
This will mainly be an issue for certain urine tests, bacterial cultures, and smears (i.e. for bv or trichomoniasis) rather than blood tests; however, some blood tests do require special collection tubes or types of preparation that may not be available in all doctors' offices.
For example, very few doctors actually follow the current universal HIV testing guidelines proposed by the CDC. Even in populations that are at high risk, doctors may be hesitant to test for HIV for a variety of reasons - including simply not realizing that they should.
One of the reasons Pap smear guidelines changed recently is the problem of over treatment. Although the screening test itself is very safe, follow-up biopsies and treatments can cause unnecessary damage to a woman's cervix and long-term reproductive health. Studies have shown that, if left untreated, many lesions will eventually spontaneously resolve on their own.
Unfortunately, many doctors are afraid to screen and not treat, because if that turns out to be the wrong decision instead of the smart decision, they're likely to get sued. This is a real and understandable fear that may make it easier for them to simply screen less often in the first place.
Although in general most people don't get tested for STDs nearly often enough, others go too often. Certain individuals may excessively worry about STDs every single time they have sex, and your doctor may be concerned about exacerbating this kind of fear.
If you are seeking frequent screening either because you have a known exposure, or because you are considering starting a new relationship and want to know where you stand, explain your logic to your doctor. He or she may be more willing to screen you in the absence of symptoms if they understand you have a good reason to want to know your STD status. It is harder to turn down someone's reasonable STD request when you know it's because they are trying to keep other people safe.
A friend recently asked her doctor to test her for herpes and was told it was impossible to test her since she didn't have any symptoms. She promptly grabbed her chart, pointed to the results from the last few times she had gotten a blood test for herpes at the same practice, and raised her eyebrow. The doctor ordered the test.
Your doctor may also know that a test exists, but doubt whether it is smart to use on you. If that is the case, discuss his concerns. They may be legit. There are, for example, good reasons rapid HIV tests are only used in high risk populations.
Some doctors may be unaware that STDs can be transmitted even when people have no symptoms. They may thus be hesitant to screen people for asymptomatic diseases, particularly those without serious long term health risks. This may be particularly true for herpes testing, where many doctors are extremely concerned about the potential emotional consequences of a false positive test.
However, since suppressive therapy may be able to reduce the risk of herpes transmission, even in the absence of symptoms, there may truly be advantages to knowing your status even when you have no symptoms -- particularly if your behavior may be putting a new sexual partner at risk. There's a reason they call STDs the hidden epidemic.
One of the biggest issues surrounding testing for extremely common and highly socially stigmatized diseases such as genital herpes and genital warts is that some doctors believe that the emotional trauma of a diagnosis causes more harm than the potential for spreading a disease asymptomatically.
It's true that finding out you have herpes or genital warts can be a life-changing experience. It can induce major depression, affect social and romantic relationships, and overall have a highly negative impact on someone's life -- even if they never have symptoms. Combined with the fact that you may live your whole life never knowing you are infected with one of these diseases, some doctors question if there is really benefit to doing the test.
It's easy to get tested for STDs if you're young and unmarried, but if you're older - whether or not you're married - many physicians may not be as worried about you as they should be. In part, this is because young people are actually at greater risk of STDs, but it's also because the older you get, the less sex your doctor tends to think you are having.
Doctors are more likely to suggest STD screening, or agree to screen you, if they think of you as "at risk." It's a false choice, though, because even many people who seem to be at low risk are far from risk-free. My favorite gynecologist screens all of her patients every year, and sees 2-3 cases of chlamydia a month in patients most other doctors wouldn't bother to test.
Who should test you for sexually transmitted diseases? Your primary care physician? Your gynecologist? Your urologist? The doctor who sees you in the emergency room when you've dropped a stove on your foot? Realistically speaking, any of those doctors could test you for most STDs, and there are circumstances in which any one of them might.
In the U.S., STD screening isn't standard care except in certain types of clinics in certain types of populations. Some blood tests are easily performed by any doctor, but other urine and swab tests require skills or expertise that they may not all have. If you're looking for STD testing because you have symptoms, your best bet is a gynecologist, urologist, or your primary care physician.